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Cancer: Prostate Message Board

Cancer: Prostate Board Index

[COLOR="DarkGreen"]Hi again Perineum,

I'll insert some thoughts about your latest post in green, and I hope they will provide some reassurance.[/COLOR]

[QUOTE=Perineum;4800486]Jim, thank you for the reply...

My friend told me that there are two options:
1. The biopsy is correct (it was reviewed, confirmed Gleason8)[/QUOTE]

[COLOR="darkgreen"]I'm glad to see it was reviewed. Provided the reviewer had a decent level of expertise, that is solid evidence of a true Gleason 8 tumor. That alone is a signal for action as it would have been most unwise to let a Gleason 8 tumor go its natural course, which is to spread fairly rapidly.[/COLOR]

[QUOTE] but nothing found in the post surgery pathology examination.
This is possible since its prostate was very large and the examination cover very little of it.[/QUOTE]

[COLOR="darkgreen"]The large size, plus the fact that thec cancer was found in only one core, are key facts which explain why the post-op biopsy missed the cancer.[/COLOR]

[QUOTE]In this case, with Gleason 8, his prognosis is not good.[/QUOTE]

[COLOR="DarkGreen"]No, that is not at all the case! In fact, radical surgery or curative radiation for a Gleason 8 tumor that is well confined is ideal treatment. If you have a Gleason 8, you definitely NEED curative treatment if the cancer is within the range of the approach. That means that it must be confined to the prostate in the case of surgery, or it must be limited to the range covered by radiation (which goes somewhat beyond the prostate). Many Gleason 8 patients do very well when their cancer has been caught early, which appears to have been the case for your friend.[/COLOR]

[QUOTE]2. The biopsy was switched with another person. Meaning that he has nothing and his life changed dramatically due to the side effects (incontinence and other).
This is possible since beside the Biopsy, all other tests were negative.
including MRI (endorectal) which found nothing.[/QUOTE]

[COLOR="darkgreen"]I still think that switching patient records is a truly remote, highly unlikely scenario. We now have a pretty good explanation why the post-op biopsy was negative. It would not be surprising for an endorectal MRI to miss a very small cancer in my layman's opinion. The same goes for a CT scan and a bone scan if they were done; it takes a fairly large tumor to show up on a CT scan, and even a bone scan requires about 10% bone involvement or more.[/COLOR]

Obviously the latter choice is the preferred one.

[QUOTE]But, he is really mad about the doctors since besides the biopst there was no evidence of cancer. His PSA was below 10.[/QUOTE]

[COLOR="darkgreen"]Gleason 8 cancers, despite the fact that they are quite aggressive, usually underproduce PSA because the cells are so broken up that they are no longer very productive. Sometimes Gleason 8 to 10 patients have high PSAs, but often they do not.[/COLOR]

[QUOTE]all imaging tests were negative. The biopsy found only 1/12 positive core !! (As opposed to what I thought before 3/12).

I mean, besides the biopsy, nothing proved cancer.[/QUOTE]

[COLOR="darkgreen"]The biopsy is the key indicator, far outstripping the other indicators. It would have been irresponsible for the doctors to have done nothing in the face of a confirmed Gleason 8 cancer even with the other indicators being negative. It appears the doctors actually took some care to ensure that the cancer was within the range of surgery, in other words, that it did not show up beyond the capsule in the endorectal MRI image.[/COLOR]

[QUOTE]They didn't mention the possibility of mistake...
They went into surgery immediately because of the Gleason 8...

And the face that he cannot know what has happened really disturb him.[/QUOTE]

[COLOR="darkgreen"]I'll suggest a couple of things. First, for his own peace of mind, he should empower himself with more knowledge about the disease and how it is treated. The Primer that I mentioned earlier is an excellent starting point, and the Prostate Cancer Research Institute (PCRI, a non-profit organization) also has some readily available, objective and highly informative resources. Second, your friend should insist that his post-op PSAs are done with an ultrasensitive version capable of reliably measuring down to <0.01. Doing this will enable him and his doctor to either spot a likely recurrence early or gain early peace of mind. Ideally, the post-op PSA, done perhaps 12 weeks after surgery (though sometimes earlier) should be <0.01. Recurrences are somewhat more likely as the numbers rise, with recurrence very likely, but not a certainty (especially with nerve sparing surgery) if the value is 0.05 or higher. Two versions I know of with this capability are the Immulite 2000 ultrasensitive PSA and the Roche ECLIA ultrasensitive PSA.[/COLOR]

[QUOTE]This is really a strange case which I couldn't find in the internet...
(Only happened with Gleason 6, maybe 7, but not >=8)[/QUOTE]

[COLOR="darkgreen"]That's probably because Gleason 8 is quite aggressive so that there is only a small window of time when the tumor is small enough that it is missed in the post-op pathology. The time window would be larger for Gleason 7, and even larger for Gleason 6 and below. Quite often Active Surveillance patients with Gleason 6 cancers will have negative biopsies after their initial biopsies.

I believe your friend was very fortunate to have caught this dangerous cancer very early. I think that in time he will come to understand that and appreciate his doctors.

Take care,

Jim :wave:


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